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Exhibitionistic Disorder
DSM-III In DSM-III, this disorder is called Exhibitionism Diagnostic Criteria Repetitive acts of exposing the genitals to an unsuspecting stranger for the purpose of achieving sexual excitement, with no attempt at further sexual activity with the stranger. Differential Diagnosis Non-sexual exposure Repeated exposure without experiencing sexual excitement from the act is engaged in by a small number of individuals. They should not receive the diagnosis of Exhibitionism since it is likely that such individuals suffer from another disorder. Pedophilia When exposure occurs in Pedophilia it is a prelude to sexual activity with the child. DSM-IV In DSM-IV, this disorder is called Exhibitionism For more information, see Paraphilias The paraphiliac focus in Exhibitionism involves the exposure of one's genitals to a stranger. Sometimes the individual masturbates while exposing himself (or while fantasizing exposing himself). If the person acts on these urges, there is generally no attempt at further sexual activity with the stranger. In some cases, the individual is aware of a desire to surprise or shock the observer. In other cases, the individual has the sexually arousing fantasy that the observer will become sexually aroused. The onset usually occurs before age 18 years, although it can begin at a later age. Few arrests are made in the older age groups, which may suggest that the condition becomes less severe after age 40 years. Diagnostic Criteria A'''. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one's genitals to an unsuspecting stranger. '''B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. DSM-5 Diagnostic Criteria A'''. Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one's genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors. '''B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify whether: * Sexually aroused by exposing genitals to prepubertal children * Sexually aroused by exposing genitals to physically mature individuals * Sexually aroused by exposing genitals to prepubertal children and to physically mature individuals Specify if: * In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to expose one's genitals are restricted. * In full remission: The individual has not acted on the urges with a nonconsenting person, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment. Subtypes The subtypes for exhibitionistic disorder are based on the age or physical maturity of the nonconsenting individuals to whom the individual prefers to expose his or her genitals. The nonconsenting individuals could be prepubescent children, adults, or both. This specifier should help draw adequate attention to characteristics of victims of individuals with exhibitionistic disorder to prevent co-occurring pedophilic disorder from being overlooked. However, indications that the individual with exhibitionistic disorder is sexually attracted to exposing his or her genitals to children should not preclude a diagnosis of pedophilic disorder. Specifiers The "in full remission" specifier does not address the continued presence or absence of exhibitionism per se, which may still be present after behaviors and distress have remitted. Differential Diagnosis Potential differential diagnoses for exhibitionistic disorders sometimes occur also as comorbid disorders. Therefore, it is generally necessary to evaluate the evidence for exhibitionistic disorder and other possible conditions as separate questions. Conduct disorder and antisocial personality disorder Conduct disorder in adolescents and antisocial personality disorder would be characterized by additional norm-breaking and antisocial behaviors, and the specific sexual interest in exposing the genitals should be lacking. Substance use disorders Alcohol and substance use disorders might involve single exhibitionistic episodes by intoxicated individuals but should not involve the typical sexual interest in exposing the genitals to unsuspecting persons. Hence, recurrent exhibitionistic sexual fantasies, urges, or behaviors that occur also when the individual is not intoxicated suggest that exhibitionistic disorder might be present.